Yves Pacheco Dias March E Souza (original) (raw)

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Papers by Yves Pacheco Dias March E Souza

Research paper thumbnail of Acute Myocarditis in Childhood and Adolescence in the Covid-19 Era

ABC: Heart Failure & Cardiomyopathy, 2021

Myocarditis in children and adolescents is an inflammatory myocardial disease with a heterogeneou... more Myocarditis in children and adolescents is an inflammatory myocardial disease with a heterogeneous presentation ranging from oligosymptomatic, with no impaired ejection fraction to catastrophic clinical presentation with cardiogenic shock (fulminant myocarditis) or sudden death. Thus, this condition remains a major challenge from the diagnostic and therapeutic points of view. Despite the different etiologies listed, the most frequent form may be related to viral diseases, and new forms of myocarditis, such allergic ones (eosinophilic and use of medications, particularly cancer immunotherapy), have been currently described. Increasing the rate of suspicion is crucial. Measurement of serum levels of troponin and N-terminal B-type natriuretic peptide, as well as the use of advanced methods of cardiac imaging, such as strain echocardiogram, positron emission tomography, and cardiac magnetic resonance, are integral part of multimodal assessment in suspected patients. Although endomyocardial biopsy remains is still the gold standard for disease diagnosis, currently it tends to be performed in specific situations, such as fulminant clinical presentation and chronic or recurrent myocarditis. The management of this condition includes general supportive care, treatment of heart failure, control of arrhythmias when present, assessment of mechanical support and cardiac transplantation. Treatments based on immunosuppression and immunotherapy are still controversial. In this article, we propose a broad review of diagnostic and treatment methods, as well as the different etiologies in the pediatric population.

Research paper thumbnail of Non-Compacted Cardiomyopathy in Children and Adolescents: From the Challenge of Echocardiographic Diagnosis to Clinical Follow-Up

ABC Imagem Cardiovascular, 2021

Background: Non-compacted cardiomyopathy (NCCM) is characterized by hypertrabeculations and deep ... more Background: Non-compacted cardiomyopathy (NCCM) is characterized by hypertrabeculations and deep recesses in the left ventricle, with a heterogeneous clinical presentation, ranging from asymptomatic patients to those with heart failure (HF), thromboembolic events and arrhythmias with risk of sudden death. As it is rare and does not have well-defined diagnostic criteria, its natural history in pediatrics is poorly understood. This study describes the clinical presentation and clinical course of patients with NCCM. Methodology: Observational, longitudinal, prospective study of pediatric patients seen at a pediatric cardiology referral center from metropolitan region II in the state of Rio de Janeiro, with NCCM phenotype on echocardiogram (ECHO) during a 2-year follow-up, from the ChARisMa registry. Results: 6 patients aged 4 to 14, with NCCM, were analyzed. Mean age 7.5 years (SD: 3.93), 3 males (50%). The patients presented HF (n=2), cardiac murmur (n=1), cardiac arrhythmia (n=1), were asymptomatic (n=1) or were under investigation for a genetic syndrome (n=1). Phenotypes on ECHO: NCCM/dilated cardiomyopathy (n=1) and NCCM/restrictive cardiomyopathy (n=1), isolated phenotype of NCCM (n=4). Cardiac magnetic resonance imaging was performed and confirmed the diagnosis (n=4). The outcomes observed were thromboembolism, indication for heart transplantation, and sustained ventricular tachycardia. Conclusions:This case series provides relevant data for pediatric NCCM as it shows its heterogeneous clinical presentation and potentially fatal complications. More prospective studies are needed for an accurate diagnosis and to allow its clinical course, therapeutic response and prognosis to be better known.

Research paper thumbnail of Non-alcoholic Fatty Liver Disease and Its Links with Inflammation and Atherosclerosis

Current Atherosclerosis Reports, 2020

Purpose of Review We summarize best data of the association between non-alcoholic fatty liver dis... more Purpose of Review We summarize best data of the association between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD). Recent Findings NAFLD has been linked with insulin resistance, obesity, and metabolic syndrome, conditions known to be associated with CVD and subclinical atherosclerosis. The rising evidence of the association between NAFLD and subclinical CVD may suggest that NAFLD is not only a marker but also may be actively involved in pathogenesis of CVD. Summary It is an overview of previous studies assessing relationships between NAFLD and markers of cardiovascular disease, as the presence of coronary artery calcification, increased arterial stiffness, and elevated carotid media thickness, in order to better understand the interplay between these conditions.

Research paper thumbnail of Acute Myocarditis in Childhood and Adolescence in the Covid-19 Era

ABC: Heart Failure & Cardiomyopathy, 2021

Myocarditis in children and adolescents is an inflammatory myocardial disease with a heterogeneou... more Myocarditis in children and adolescents is an inflammatory myocardial disease with a heterogeneous presentation ranging from oligosymptomatic, with no impaired ejection fraction to catastrophic clinical presentation with cardiogenic shock (fulminant myocarditis) or sudden death. Thus, this condition remains a major challenge from the diagnostic and therapeutic points of view. Despite the different etiologies listed, the most frequent form may be related to viral diseases, and new forms of myocarditis, such allergic ones (eosinophilic and use of medications, particularly cancer immunotherapy), have been currently described. Increasing the rate of suspicion is crucial. Measurement of serum levels of troponin and N-terminal B-type natriuretic peptide, as well as the use of advanced methods of cardiac imaging, such as strain echocardiogram, positron emission tomography, and cardiac magnetic resonance, are integral part of multimodal assessment in suspected patients. Although endomyocardial biopsy remains is still the gold standard for disease diagnosis, currently it tends to be performed in specific situations, such as fulminant clinical presentation and chronic or recurrent myocarditis. The management of this condition includes general supportive care, treatment of heart failure, control of arrhythmias when present, assessment of mechanical support and cardiac transplantation. Treatments based on immunosuppression and immunotherapy are still controversial. In this article, we propose a broad review of diagnostic and treatment methods, as well as the different etiologies in the pediatric population.

Research paper thumbnail of Non-Compacted Cardiomyopathy in Children and Adolescents: From the Challenge of Echocardiographic Diagnosis to Clinical Follow-Up

ABC Imagem Cardiovascular, 2021

Background: Non-compacted cardiomyopathy (NCCM) is characterized by hypertrabeculations and deep ... more Background: Non-compacted cardiomyopathy (NCCM) is characterized by hypertrabeculations and deep recesses in the left ventricle, with a heterogeneous clinical presentation, ranging from asymptomatic patients to those with heart failure (HF), thromboembolic events and arrhythmias with risk of sudden death. As it is rare and does not have well-defined diagnostic criteria, its natural history in pediatrics is poorly understood. This study describes the clinical presentation and clinical course of patients with NCCM. Methodology: Observational, longitudinal, prospective study of pediatric patients seen at a pediatric cardiology referral center from metropolitan region II in the state of Rio de Janeiro, with NCCM phenotype on echocardiogram (ECHO) during a 2-year follow-up, from the ChARisMa registry. Results: 6 patients aged 4 to 14, with NCCM, were analyzed. Mean age 7.5 years (SD: 3.93), 3 males (50%). The patients presented HF (n=2), cardiac murmur (n=1), cardiac arrhythmia (n=1), were asymptomatic (n=1) or were under investigation for a genetic syndrome (n=1). Phenotypes on ECHO: NCCM/dilated cardiomyopathy (n=1) and NCCM/restrictive cardiomyopathy (n=1), isolated phenotype of NCCM (n=4). Cardiac magnetic resonance imaging was performed and confirmed the diagnosis (n=4). The outcomes observed were thromboembolism, indication for heart transplantation, and sustained ventricular tachycardia. Conclusions:This case series provides relevant data for pediatric NCCM as it shows its heterogeneous clinical presentation and potentially fatal complications. More prospective studies are needed for an accurate diagnosis and to allow its clinical course, therapeutic response and prognosis to be better known.

Research paper thumbnail of Non-alcoholic Fatty Liver Disease and Its Links with Inflammation and Atherosclerosis

Current Atherosclerosis Reports, 2020

Purpose of Review We summarize best data of the association between non-alcoholic fatty liver dis... more Purpose of Review We summarize best data of the association between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD). Recent Findings NAFLD has been linked with insulin resistance, obesity, and metabolic syndrome, conditions known to be associated with CVD and subclinical atherosclerosis. The rising evidence of the association between NAFLD and subclinical CVD may suggest that NAFLD is not only a marker but also may be actively involved in pathogenesis of CVD. Summary It is an overview of previous studies assessing relationships between NAFLD and markers of cardiovascular disease, as the presence of coronary artery calcification, increased arterial stiffness, and elevated carotid media thickness, in order to better understand the interplay between these conditions.